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Webster KE, George B, Lee A, Galbraith K, Harrington-Benton NA, Judd O, Kaski D, Maarsingh OR, MacKeith S, Murdin L, Ray J, Van Vugt VA, Burton MJ. Lifestyle and dietary interventions for Ménière's disease. Cochrane Database Syst Rev 2023; 2:CD015244. [PMID: 36848645 PMCID: PMC9969956 DOI: 10.1002/14651858.cd015244.pub2] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/01/2023]
Abstract
BACKGROUND Ménière's disease is a condition that causes recurrent episodes of vertigo, associated with hearing loss and tinnitus. Lifestyle or dietary modifications (including reducing the amount of salt or caffeine in the diet) are sometimes suggested to be of benefit for this condition. The underlying cause of Ménière's disease is unknown, as is the way in which these interventions may work. The efficacy of these different interventions at preventing vertigo attacks, and their associated symptoms, is currently unclear. OBJECTIVES To evaluate the benefits and harms of lifestyle and dietary interventions versus placebo or no treatment in people with Ménière's disease. SEARCH METHODS The Cochrane ENT Information Specialist searched the Cochrane ENT Register; Central Register of Controlled Trials (CENTRAL); Ovid MEDLINE; Ovid Embase; Web of Science; ClinicalTrials.gov; ICTRP and additional sources for published and unpublished trials. The date of the search was 14 September 2022. SELECTION CRITERIA We included randomised controlled trials (RCTs) and quasi-RCTs in adults with Ménière's disease comparing any lifestyle or dietary intervention with either placebo or no treatment. We excluded studies with follow-up of less than three months, or with a cross-over design (unless data from the first phase of the study could be identified). DATA COLLECTION AND ANALYSIS: We used standard Cochrane methods. Our primary outcomes were: 1) improvement in vertigo (assessed as a dichotomous outcome - improved or not improved), 2) change in vertigo (assessed as a continuous outcome, with a score on a numerical scale) and 3) serious adverse events. Our secondary outcomes were: 4) disease-specific health-related quality of life, 5) change in hearing, 6) change in tinnitus and 7) other adverse effects. We considered outcomes reported at three time points: 3 to < 6 months, 6 to ≤ 12 months and > 12 months. We used GRADE to assess the certainty of evidence for each outcome. MAIN RESULTS: We included two RCTs, one related to diet, and the other related to fluid intake and sleep. In a Swedish study, 51 participants were randomised to receive 'specially processed cereals' or standard cereals. The specially processed cereals are thought to stimulate the production of anti-secretory factor - a protein that reduces inflammation and fluid secretion. Participants received the cereals for three months. The only outcome reported by this study was disease-specific health-related quality of life. The second study was conducted in Japan. The participants (223) were randomised to receive abundant water intake (35 mL/kg/day), or to sleep in darkness (in an unlit room for six to seven hours per night), or to receive no intervention. The duration of follow-up was two years. The outcomes assessed were 'improvement in vertigo' and hearing. As these studies considered different interventions we were unable to carry out any meta-analysis, and for almost all outcomes the certainty of the evidence was very low. We are unable to draw meaningful conclusions from the numerical results. AUTHORS' CONCLUSIONS The evidence for lifestyle or dietary interventions for Ménière's disease is very uncertain. We did not identify any placebo-controlled RCTs for interventions that are frequently recommended for those with Ménière's disease, such as salt restriction or caffeine restriction. We identified only two RCTs that compared a lifestyle or dietary intervention to placebo or no treatment, and the evidence that is currently available from these studies is of low or very low certainty. This means that we have very low confidence that the effects reported are accurate estimates of the true effect of these interventions. Consensus on the appropriate outcomes to measure in studies of Ménière's disease is needed (i.e. a core outcome set) in order to guide future studies in this area and enable meta-analyses of the results. This must include appropriate consideration of the potential harms of treatment, as well as the benefits.
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Affiliation(s)
- Katie E Webster
- Cochrane ENT, Nuffield Department of Surgical Sciences, University of Oxford, Oxford, UK
| | - Ben George
- Corpus Christi College, University of Oxford, Oxford, UK
| | - Ambrose Lee
- Department of Otolaryngology - Head and Neck Surgery, University of Toronto, Toronto, Canada
| | - Kevin Galbraith
- Cochrane ENT, Nuffield Department of Surgical Sciences, University of Oxford, Oxford, UK
| | | | - Owen Judd
- ENT Department, University Hospitals of Derby and Burton NHS Foundation Trust, Derby, UK
| | - Diego Kaski
- National Hospital for Neurology and Neurosurgery, London, UK
| | - Otto R Maarsingh
- Department of General Practice, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam Public Health Research Institute, Amsterdam, Netherlands
| | - Samuel MacKeith
- ENT Department, Oxford University Hospitals NHS Foundation Trust, Oxford, UK
| | - Louisa Murdin
- ENT Department, Guy's and St Thomas' NHS Foundation Trust, London, UK
| | | | - Vincent A Van Vugt
- Department of General Practice, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam Public Health Research Institute, Amsterdam, Netherlands
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Ehinger E, Kopecky J, Darabi A, Visse E, Edvardsson C, Tomasevic G, Cederberg D, Belting M, Bengzon J, Siesjö P. Antisecretory factor is safe to use as add-on treatment in newly diagnosed glioblastoma. BMC Neurol 2023; 23:76. [PMID: 36803465 PMCID: PMC9938624 DOI: 10.1186/s12883-023-03119-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2022] [Accepted: 02/13/2023] [Indexed: 02/19/2023] Open
Abstract
PURPOSE Glioblastoma (GBM) is the most common primary malignant brain tumor in adults. Despite the best available treatment, prognosis remains poor. Current standard therapy consists of surgical removal of the tumor followed by radiotherapy and chemotherapy with the alkylating agent temozolomide (TMZ). Experimental studies suggest that antisecretory factor (AF), an endogenous protein with proposed antisecretory and anti-inflammatory properties, may potentiate the effect of TMZ and alleviate cerebral edema. Salovum is an egg yolk powder enriched for AF and is classified as a medical food in the European Union. In this pilot study, we evaluate the safety and feasibility of add-on Salovum in GBM patients. METHODS Eight patients with newly diagnosed, histologically confirmed GBM were prescribed Salovum during concomitant radiochemotherapy. Safety was determined by the number of treatment-related adverse events. Feasibility was determined by the number of patients who completed the full prescribed Salovum treatment. RESULTS No serious treatment-related adverse events were observed. Out of 8 included patients, 2 did not complete the full treatment. Only one of the dropouts was due to issues directly related to Salovum, which were nausea and loss of appetite. Median survival was 23 months. CONCLUSIONS We conclude that Salovum is safe to use as an add-on treatment for GBM. In terms of feasibility, adherence to the treatment regimen requires a determined and independent patient as the large doses prescribed may cause nausea and loss of appetite. TRIAL REGISTRATION ClinicalTrials.gov NCT04116138. Registered on 04/10/2019.
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Affiliation(s)
- Erik Ehinger
- Neurosurgery, Department of Clinical Sciences, Lund University, Skåne University Hospital, Lund, Sweden. .,Glioma Immunotherapy Group, Neurosurgery, Department of Clinical Sciences, Lund University, Lund, Sweden.
| | - Jan Kopecky
- grid.4514.40000 0001 0930 2361Glioma Immunotherapy Group, Neurosurgery, Department of Clinical Sciences, Lund University, Lund, Sweden
| | - Anna Darabi
- grid.4514.40000 0001 0930 2361Glioma Immunotherapy Group, Neurosurgery, Department of Clinical Sciences, Lund University, Lund, Sweden
| | - Edward Visse
- grid.4514.40000 0001 0930 2361Glioma Immunotherapy Group, Neurosurgery, Department of Clinical Sciences, Lund University, Lund, Sweden
| | - Charlotte Edvardsson
- grid.4514.40000 0001 0930 2361Neurosurgery, Department of Clinical Sciences, Lund University, Skåne University Hospital, Lund, Sweden
| | - Gregor Tomasevic
- grid.4514.40000 0001 0930 2361Neurosurgery, Department of Clinical Sciences, Lund University, Skåne University Hospital, Lund, Sweden
| | - David Cederberg
- grid.4514.40000 0001 0930 2361Neurosurgery, Department of Clinical Sciences, Lund University, Skåne University Hospital, Lund, Sweden
| | - Mattias Belting
- grid.4514.40000 0001 0930 2361Oncology, Department of Clinical Sciences, Lund University, Skåne University Hospital, Lund, Sweden ,grid.8993.b0000 0004 1936 9457Department of Immunology, Genetics and Pathology, Science for Life Laboratory, Uppsala University, Uppsala, Sweden ,grid.411843.b0000 0004 0623 9987Department of Hematology, Oncology and Radiophysics, Skåne University Hospital, Lund, Sweden
| | - Johan Bengzon
- grid.4514.40000 0001 0930 2361Neurosurgery, Department of Clinical Sciences, Lund University, Skåne University Hospital, Lund, Sweden ,grid.4514.40000 0001 0930 2361Lund Stem Cell Center, Department of Clinical Sciences, Lund University, Lund, Sweden
| | - Peter Siesjö
- grid.4514.40000 0001 0930 2361Neurosurgery, Department of Clinical Sciences, Lund University, Skåne University Hospital, Lund, Sweden ,grid.4514.40000 0001 0930 2361Glioma Immunotherapy Group, Neurosurgery, Department of Clinical Sciences, Lund University, Lund, Sweden
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Nutraceuticals for Peripheral Vestibular Pathology: Properties, Usefulness, Future Perspectives and Medico-Legal Aspects. Nutrients 2021; 13:nu13103646. [PMID: 34684646 PMCID: PMC8538675 DOI: 10.3390/nu13103646] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2021] [Revised: 10/09/2021] [Accepted: 10/13/2021] [Indexed: 02/07/2023] Open
Abstract
Vestibular disorders may generate complex signs and symptoms, which may alter patients' balance and the quality of life. Dizziness and vertigo can strongly affect daily activities and relations. Despite the presence of conventional drugs, maneuvers, and surgery, another interesting therapeutic opportunity is offered by nutraceuticals. These molecules are often used in the treatment of dizziness and vertigo, but the rationale of their application is not always solidly demonstrated by the scientific evidence. Several substances have shown a variable level of efficacy/usefulness in this field, but there is lack of important evidence for most of them. From a medico-legal point of view, specific information must be provided to the patient regarding the efficacy and possibilities that the use of these preparations can allow. Administering the right nutraceutical to the proper patient is a fundamental clinical skill. Integrating conventional drug treatment with nutraceutical administration seems to be easy, but it may be difficult considering the (in part unexplored) pharmacodynamics and pharmacokinetics of nutraceuticals. The aim of the scientific community should be to elevate nutraceuticals to the same law and technical dignity of conventional drugs.
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Oğuz E, Cebeci A, Geçici CR. The relationship between nutrition and Ménière's disease. Auris Nasus Larynx 2021; 48:803-808. [PMID: 33773852 DOI: 10.1016/j.anl.2021.03.006] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2021] [Revised: 02/13/2021] [Accepted: 03/02/2021] [Indexed: 10/21/2022]
Abstract
Ménière's disease is an inner ear disease with attacks characterized by ear fullness, tinnitus, fluctuant sensorineural hearing loss and vertigo. Although pathophysiology of the disease is not fully known, endolymphatic hydrops are believed to play a role. Although there is no certain treatment procedure for Ménière's disease, some treatments are applied to prevent attacks, to treat the symptoms that occur during the attacks, and to prevent the permanent effects of the symptoms on the hearing and balance system. Lifestyle changes, dietary modifications, diuretics, vasodilator corticosteroids, intratympanic steroids, surgical methods are some of these treatment methods. Dietary modification includes a low sodium diet, a reduction in daily alcohol and caffeine intake, a gluten-free diet, and a new dietary approach to specially processed grains, all of which are first-line treatments. The goal of this review article is to examine the relationship between MD and dietary intervention, which is frequently used in the prevention and treatment of MD attacks.
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Affiliation(s)
- Esma Oğuz
- Department of Nutrition and Dietetics, Institute of Health Sciences, Marmara University, Istanbul, Turkey
| | - Aybike Cebeci
- Department of Nutrition and Dietetics, Institute of Health Sciences, Marmara University, Istanbul, Turkey
| | - Cennet Reyyan Geçici
- Department of Audiology, Faculty of Health Sciences, Marmara University, Istanbul, Turkey.
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Viola P, Pisani D, Scarpa A, Cassandro C, Laria C, Aragona T, Ciriolo M, Spadera L, Ralli M, Cavaliere M, Iengo M, Chiarella G. The role of endogenous Antisecretory Factor (AF) in the treatment of Ménière's Disease: A two-year follow-up study. Preliminary results. Am J Otolaryngol 2020; 41:102673. [PMID: 32829060 DOI: 10.1016/j.amjoto.2020.102673] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2020] [Revised: 07/15/2020] [Accepted: 08/09/2020] [Indexed: 12/11/2022]
Abstract
PURPOSE To evaluate the effects of increased endogenous Antisecretory Factor (AF) synthesis using specially processed cereals (SPC) in a sample of patients with defined unilateral Meniere's disease (MD), compared to the results of a treatment protocol of intravenous glycerol and dexamethasone. MATERIALS AND METHODS Twenty-six patients with unilateral MD were divided in 2 groups and treated with SPC and with intravenous glycerol and dexamethasone for 24 months. Audio-vestibular evaluation was performed before (T0) and every six months. The number of vertigo spells were evaluated before and after therapy and the Efficacy Index (EI) was calculated. Questionnaires for hearing loss, tinnitus and quality of life were administered. RESULTS EI decreased in the SPC group after 18 (T18) (p = .0017) and 24 (T24) months of therapy (p = .0111). There was a significant reduction for tinnitus score in the SPC group at T24 (p = .0131). No significant differences were found between the two groups at T0 (p = .4723), while a significant difference was found at T24 (p = .0027). Quality of life showed a significant improvement in daily activities in the SPC group (p = .0033) compared to the infusion therapy group. No statistically significant changes in PTA thresholds were found in both groups between T0 and T24. CONCLUSION The preliminary results of our study show a significant reduction of vertigo spells and a positive effect on tinnitus severity and on quality of life in patients with unilateral MD treated with SPC and when compared to patients treated with intravenous glycerol and dexamethasone. No effects on hearing thresholds were noted in both groups.
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Affiliation(s)
- Pasquale Viola
- Department of Experimental and Clinical Medicine, Unit of Audiology, Regional Centre for Cochlear Implants and ENT Diseases, Magna Graecia University, Catanzaro, Italy
| | - Davide Pisani
- Department of Experimental and Clinical Medicine, Unit of Audiology, Regional Centre for Cochlear Implants and ENT Diseases, Magna Graecia University, Catanzaro, Italy
| | - Alfonso Scarpa
- Department of Medicine and Surgery, University of Salerno, Salerno, Italy.
| | | | - Carla Laria
- Department of Neurosciences, Reproductives and Odontostomatologic Sciences, Unit of Audiology, University of Naples "Federico II", Naples, Italy
| | | | - Marco Ciriolo
- Department of Experimental and Clinical Medicine, Unit of Audiology, Regional Centre for Cochlear Implants and ENT Diseases, Magna Graecia University, Catanzaro, Italy
| | - Lucrezia Spadera
- Otolaryngology, San Leonardo Hospital, Castellammare di Stabia, Napoli, Italy
| | - Massimo Ralli
- Department of Sense Organs, Sapienza University of Rome, Rome, Italy
| | - Michele Cavaliere
- Department of Neurosciences, Reproductives and Odontostomatologic Sciences, Unit Ear, Nose and Throat Section, University of Naples "Federico II", Naples, Italy
| | - Maurizio Iengo
- Department of Neurosciences, Reproductives and Odontostomatologic Sciences, Unit Ear, Nose and Throat Section, University of Naples "Federico II", Naples, Italy
| | - Giuseppe Chiarella
- Department of Experimental and Clinical Medicine, Unit of Audiology, Regional Centre for Cochlear Implants and ENT Diseases, Magna Graecia University, Catanzaro, Italy
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Scarpa A, Ralli M, Viola P, Cassandro C, Alicandri-Ciufelli M, Iengo M, Chiarella G, de Vincentiis M, Cavaliere M, Cassandro E. Food-induced stimulation of the antisecretory factor to improve symptoms in Meniere's disease: our results. Eur Arch Otorhinolaryngol 2019; 277:77-83. [PMID: 31605188 DOI: 10.1007/s00405-019-05682-4] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2019] [Accepted: 10/01/2019] [Indexed: 02/05/2023]
Abstract
PURPOSE Specially processed cereals (SPC) that increase endogenous antisecretory factor (AF) synthesis have been proposed to improve symptoms of Meniere's disease (MD) with controversial results. The aim of this study was to evaluate the effects of SPC in patients with definite unilateral MD and compare the results to a treatment protocol with intravenous glycerol and dexamethasone. METHODS Thirteen patients with unilateral MD were treated with SPC and 13 patients were treated with intravenous glycerol and dexamethasone for 12 months. Audio-vestibular evaluation was performed before (T0) and at the end of the treatments (T12). The number of vertigo spells were evaluated before and after therapy and the Efficacy Index (EI) was calculated. Questionnaires for hearing loss (HHIA), tinnitus (THI) and quality of life (TFL) were administered. RESULTS EI decreased in the SPC group in the second semester compared to the first although not significantly (p = 0.6323). There was a significant reduction for THI score in the SPC group at T12 (p = 0.0325). No significant differences were found between the two groups at T0 (p = 0.4723), while a significant difference was found at T12 (p = 0.0041). Quality of life showed an improvement in daily activities in the SPC group compared to infusion therapy group. CONCLUSION Our study shows a reduced number of vertigo attacks and a positive effect on the discomfort generated by tinnitus and quality of life in patients with unilateral MD treated with SPC and when compared to patients treated with intravenous glycerol and dexamethasone. No effects on hearing thresholds were noted in both groups.
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Affiliation(s)
- Alfonso Scarpa
- Department of Medicine and Surgery, University of Salerno, Salerno, Italy
| | - Massimo Ralli
- Department of Sense Organs, Sapienza University of Rome, Viale del Policlinico 155, 00186, Rome, Italy.
| | - Pasquale Viola
- Unit of Audiology, Department of Experimental and Clinical Medicine, Regional Centre for Cochlear Implants and ENT Diseases, Magna Graecia University, Catanzaro, Italy
| | | | | | - Maurizio Iengo
- Department of Neuroscience, Reproductive and Odontostomatologic Science, Ear, Nose and Throat Section, University of Naples ''Federico II'', Napoli, Italy
| | - Giuseppe Chiarella
- Unit of Audiology, Department of Experimental and Clinical Medicine, Regional Centre for Cochlear Implants and ENT Diseases, Magna Graecia University, Catanzaro, Italy
| | - Marco de Vincentiis
- Department of Sense Organs, Sapienza University of Rome, Viale del Policlinico 155, 00186, Rome, Italy
| | - Michele Cavaliere
- Department of Neuroscience, Reproductive and Odontostomatologic Science, Ear, Nose and Throat Section, University of Naples ''Federico II'', Napoli, Italy
| | - Ettore Cassandro
- Department of Medicine and Surgery, University of Salerno, Salerno, Italy
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